The Risk Factors Of Heart Failure With Mid-range Ejection Fraction:A Meta-analysis

Objective To systematically analyze the risk factors of heart failure with mid-range ejection fraction(HFmr EF),and then explore the mechanism of HFmr EF and provide evidencebased medicine evidence for clinical intervention and effective treatment.Methods Searching literatures published during last five years about risk factors of heart failure with mid-range ejection fraction from the Cochrane Library,Web of Science,Pub Med,Embase,Wanfang database,CNKI,CBM,VIP database and performing metaanalysis with Stata15.1.Results A total of 12 studies were included,involving 12735 HFmr EF patients and 51411 non--HFmr EF patients.Meta-analysis results show that coronary artery disease retrospective[OR=1.51,95%CI(1.33,1.72)],hypertension[OR=1.22,95%CI(1.08,1.38)],diabetes mellitus [OR=1.15,95%CI(1.02,1.31)],history of revascularization [OR=1.29,95%CI(1.02,1.62)],history of myocardial infarction [OR=1.28,95%CI(1.06,1.54)],dyslipidemia[OR=1.29,95%CI(1.10,1.52)],are the risk factors for HFmr EF.As for the history of ICD/CRT implantation [OR=0.46,95%CI(0.40,0.53)],hypertensive heart disease [OR=0.75,95%CI(0.59,0.94)],metaanalysis results indicate they are protective factors of HFmr EF.Subgroup analysis indicates that ischemic heart disease population from Asian [OR=2.58,95%CI(2.18,3.06)],renal insufficiency population from registration center [OR=1.31,95%CI(1.07,1.60)] are risk factors of HFmr EF.As for atrial fibrillation,the population from registration center [OR=1.13,95%CI(1.08,1.19)] and inpatient [OR=0.84,95%CI(0.75,0.93)] show controversial results.Serum sodium level [WMD=0.42,95%CI(0.23,0.60)],serum uric acid level [WMD=-24.77,95%CI(-45.38,-4.16)],there were differences between two groups.Smoking history [OR=0.84,95%CI(0.76,0.94)],hypertrophic cardiomyopathy [OR=0.57,95%CI (0.40,0.82)],dilated cardiomyopathy [OR=0.64,95%CI(0.52,0.80)],while the results are not stable.Conclusion: HFmr EF is a unique subtype of heart failure.Coronary artery disease,hypertension,diabetes mellitus,history of myocardial infarction,history of revascularization,dyslipidemia are risk factors of HFmr EF.The history of ICD/CRT implantation and hypertensive heart disease are protective factors of HFmr EF.By subgroup analysis,the population form registry results indicate that renal insufficiency,atrial fibrillation are risk factors of HFmr EF,the population from Asian indicate that ischemic heart disease is risk factor of HFmr EF.Results about smoking,hypertrophic cardiomyopathy and dilated cardiomyopathy are inconsistent and still need further investigation.